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  	<h1>PART FOUR: Preferred Role in Treatment Decision Making</h1>
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  		Please select the <b>ONE</b> statement that best describes the role you would prefer to play in making a treatment decision with your <b><u>urologist.</u></b><br>
  	
  		<input type="radio" name="question1"> 1. I prefer to make the final treatment choice after seriously considering my <br>
  		&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<b>urologist’s</b> opinion about which treatment would be best for me. <br>
    	<input type="radio" name="question1"> 2. I prefer that my <b>urologist</b> and I make the treatment decision together. <br>
    	<input type="radio" name="question1"> 3. I prefer that my <b>urologist</b> decides what would be the best treatment for me after <br>
    	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;s/he seriously considers my opinion.<br><br>
    											
    	Do you have a preference for a particular treatment at this time? (Please check only one)<br>
  	
  		<input type="radio" name="question2"> 1.Prostatectomy (surgery) <br>
    	<input type="radio" name="question2"> 2.Brachytherapy (seed implant) <br>
    	<input type="radio" name="question2"> 3.External beam radiation <br>
    	<input type="radio" name="question2"> 4.Active Surveillance <br><br>
    	
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